HomeMy WebLinkAboutDrain Layers Permits 399 Foster Street (2) 1400015 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER DRAIN LAYER PERMIT
DATE: 06/03/2014
GIS ID: 33600399 FEE: 60.00
MUNIS APPLICATION 4 201400704 4Fg`Oro EXPIRATION DATE: 07/03/2014
APPLICA r{yT r LOCATION
NAME: WASTEWATER SE ICE S �DDRE, ,s 9 F�TER STREET
ADDRESS: 21 COURTNEYDRI XA A.,F (�WN11R1�D��IVIIKE
ELLINGTON,CT O ��-FO I ER STREET
4 utT�m—andsor,CT 06074
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PHONE
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WORK DESCRIPTION: NEWS
THE DRAIN LAYER ASSIGNED TO THIS 1>tiI�T�H ,S1Ib LIEIS ISSUED �� SIATE AND HEREBY AGREES TO ALL
THE TERMS AND CONDITIONS SET FOR�HNIEtATTACTrD` ONDI T10I5JI L CORK SHALL BE IN ACCORDANCE WITH
THE TOWN OF SOUTH WINDSOR STANDAT�-p8,EA Ll OSI A Q JIREM$NTS3 AMID fi TE ATTACHED CONDITIONS.
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ISSUED BY DATE INSPECTED INSPECTED BY
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
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PERMIT NO.: Z Z&5Q/� CONTRACTOR: j4 ,4*L9Z
LOCATION:
TYPE OF WORK: ��
DATE INSP NEEDED: DATE INSP: 6. 6- 4
INSPECTED BY:_,
WORK IN
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SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES q NO
AS-BUILT:
INPUT: DATE:
S/2014 Town of South Windsor INPSECTION REPORT 14
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: g �s lei S Lot #
Street No. Street Name
Premises owned by: /14" ze
Name of Firm: J�- s us �� Phone: &O 1-Zb'i,6
Address of Firm: Z
TYPE OF WORK:
Lay House Drain k ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with " SPR3s—
Existing Water Supply: Public Water_ Well
Proposed Start Date rd Y Estimated time for completion r
0-7
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to o /.1,/4" the holder of Drain
Layer's License No. 7 0 77 z S . Only holders of P1 or P7 licenses will be
issued a permit. PERMIT WILL EXPIRE THIRTY (30) DAYS AFTER DATE OF
ISSUANCE. The undersigned Drain Layer hereby agrees to all the terms and
conditions set forth in the permit and attached thereto. Applicant has received Town
Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No. Z-o 1y Z S 61-7 3-s-
Signed: Print Name:
L ensed Drain Layer
Date: (�- 2— 14-
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: q
- BUILDING ADDRESS ? ._
STREET : Fo i �'T.
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S S ERVISOR (PRINT)
I C.OU{{\ $��� � � _ _
STREET ADDRESS SIGNAT RE
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TOWN
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TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
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